Background/aims The Victorian Paediatric Emergency Transport Service (PETS) transports critically unwell children from referring to tertiary paediatric hospitals. One-third are dropped in Emergency Departments (ED), rather than ICU (with the intended destination a general ward). The Australian government dictates that patients stay less than 4 h in ED. We describe this cohort’s clinical care needs and process measures.

Methods A retrospective chart review of patients retrieved by PETS to the Royal Children’s Hospital (Melbourne, Australia) ED in 2012. Demographics, illness type and parameters, process measures are related to ED length of stay (LOS) and time to ward-readiness (time at which physiological parameters stabilised and intensive treatments ceased).

Results In 2012, 120 patients were transported to the ED. Diagnoses included asthma (22), seizures (19), croup (15) and bronchiolitis (14). The median ED LOS was 4.8 h (IQR 2.9,7.7). On arrival, 73 (60.8%) were ward-ready, but only 31 (26%) were transferred to the ward within 4 h. 25 (20.8%) patients stayed longer than 8 h in ED. 25 (20.8%) had abnormal vital signs after 4 h of ED care. Lower respiratory tract disease (asthma, bronchiolitis and pneumonia) and derangement of physiological criteria on ED arrival were both associated with prolonged LOS and delayed ward readiness.

Conclusions Most retrieval patients stay too long in the ED. Administrative delays (primarily access block) is the dominant factor, however patients with asthma and bronchiolitis tend to stay longer and require longer periods of ED-based intensive treatment. This can be used to improve pre-arrival coordination and decision-making.